Midweek Update

David Ermer–Uncategorized–

Becker’s Hospital Review reports that the Blue Cross Blue Shield Association CEO Scott Serota, who has been in office since 2000, plans to retire at the end of next year.

The same publication further informs us that

OptumCare, the healthcare delivery unit of UnitedHealth Group, won’t own inpatient care or post-acute care services, the health insurer’s CEO said during an annual strategy conference, according to Business Insider. 

When asked by an analyst at the Sanford C. Bernstein 2019 Annual Strategic Decisions Conference in New York City whether UnitedHealth plans to expand OptumCare, CEO David Wichmann and CFO John Rex said they want to build out the company to generate $100 billion in annual revenue by 2028. That’s up from $16 billion last year.  

The executives said they’ll expand their footprint in areas outside of the hospital. These include urgent care practices, surgical centers and primary care offices. 

Mr. Wichmann said while it won’t be building any hospitals, he does see the insurer partnering with health systems for hospital-based services. 

Express Scripts recently announced that beginning next year it will offer plan sponsors a digital health technology formulary that

will help payers ensure the safety, effectiveness and usability of digital health technology tools made available to their members. Available in 2020, the digital health formulary will be a curated list of technology- and software-enabled applications and devices that help patients prevent, manage or treat a medical condition. 

By adopting a digital health formulary, plan sponsors can confidently deploy a digital health product to their members knowing it has been through a uniform review process to ensure its safety, quality, usability and affordability. The digital health formulary also will:

  • reduce the administrative burden for plan sponsors associated with contracting and managing digital health companies,
  • help improve affordability by leveraging Express Scripts’ size and scale in the purchasing of digital health products, and
  • create a pathway to cover the increasing number of prescription-only digital therapeutics that are coming to market.

Initially, the digital health formulary will include solutions for diabetes, cardiovascular, behavioral health and pulmonary conditions, and will later expand to include tools for other chronic and complex conditions. 

What will they think of next? 
Finally, in this year’s OPM call letter for benefit and rate proposals, OPM asked FEHB plans to consider helping control the dispensing of opioids to women who give birth by caesarian section. The Wall Street Journal reports that several top hospitals have developed a solution to the problem:

Fairview [Hospital, a member of he Cleveland Clinic system] started a pilot program in March 2018. Nurses started explaining to women that they were trying to reduce opioid use. They offered to alternate large doses of ibuprofen (Motrin) with acetaminophen (Tylenol) every three hours. Women could still request oxycodone, an opioid, for “breakthrough” pain. 

The hospital’s opioid use in C-section patients immediately dropped by more than two-thirds, Dr. Chiang says. Opioid-free hospital stays have increased to 44% from 12% over the past year. 

“The patients were doing much better. They were more awake and not so sleepy or lethargic,” Dr. Chiang says. Two other Cleveland Clinic hospitals with maternity wards also changed their protocols last year. 

Bravo.